EXPAREL in obstetrics and gynecologic surgery

Administration volume and technique are critical to achieving optimal results

The videos below include a variety of surgical procedures that demonstrate examples of how to administer EXPAREL for optimal pain control and coverage.

TAP Block in C-Section (Surgical Site Infiltration)Performed by: Dr Cherot

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This video represents an individual clinician experience with and methodology for using EXPAREL.

Pacira BioSciences, Inc., recognizes that there are other methodologies for administering local anesthetics, as well as individual patient considerations, when selecting the dose for a specific procedure.

Please see Important Safety Information below and refer to the Full Prescribing Information.

More Videos

TAP Block in C-Section (Surgical Site Infiltration) Performed by: Dr Cherot

TAP Block in C-Section (Surgical Site Infiltration) Performed by: Dr Cherot

TAP Block in Open Hysterectomy Performed by: Dr Hutchins

TAP Block in Open Hysterectomy Performed by: Dr Hutchins

TAP Block in Open Myomectomy (Surgical Site Infiltration) Performed by: Dr McCarus

TAP Block in Open Myomectomy (Surgical Site Infiltration) Performed by: Dr McCarus

Case reports

Cost and value

Clinical & Economic Outcomes

Multimodal approaches with or without ERAS protocols have demonstrated benefits in obstetric and gynecologic procedures

  • Reduced opioid use and risk of ORAEs1-5
  • Fewer postsurgical complications3
  • Higher patient satisfaction2,3
  • Earlier mobility1,6
  • Shorter hospital LOS3,4
  • Reduced healthcare costs4

Clinical data support the use of EXPAREL

Transversus abdominis plane block with liposomal bupivacaine for pain control after cesarean delivery

Read the publication

Transversus abdominis plane block with liposomal bupivacaine for pain after cesarean delivery in a multicenter, randomized, double-blind, controlled trial

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Leading medical societies recommend opioid-minimizing pain management strategies to enhance recovery after obstetric and gynecologic procedures

ACOG6

  • A stepwise, multimodal pain management strategy, including local anesthetics delivered by wound infiltration or TAP block, is recommended to control pain and minimize opioid administration
  • Postoperative minimization of opioid use reduces nausea and vomiting, impairment of bowel function, delayed mobilization, and pulmonary morbidity

SOAP1

  • Multimodal analgesia, including wound infiltration or regional blocks (eg, TAP block), should be used to reduce pain, improve mobilization, reduce opioid use in the hospital after discharge, and decrease opioid side effects

SGO7

  • Advocate for the goal of reducing opioid misuse, and optimizing availability and use of non-opioid methods of pain control

ERAS2

  • Avoiding opioid use within a multimodal postoperative analgesia pathway, with greater emphasis on non-opioid medications such as liposomal bupivacaine, can improve patient experience and functional recovery after surgery

ACOG, American College of Obstetrics and Gynecologists; ERAS, enhaced recovery after surgery; LOS, length of stay; SGO, Society of Gynecologic Oncology; SOAP, Society for Obstetric Anesthesia and Perinatology; ORAE, opioid-related adverse events; TAP, transversus abdominis plane.

LEARN ABOUT OPIOID-MINIMIZATION IN GYNECOLOGIC SURGERIES
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Important Notice

This site is intended to provide medical and product information to health care professionals in the United States.

To report an adverse event, email drugsafety@pacira.com or call 1-855-793-9727.

For medical inquiries related to EXPAREL, submit a request to Medical Information or call 1-855-793-9727.

These are not all of the potential important safety considerations for EXPAREL; please see the full Prescribing Information.

References

  1. Society of Obstetric Anesthesia and Perinatology (SOAP) Enhanced Recovery After Cesarean (ERAC) Consensus Statement. Society of Obstetric Anesthesia and Perinatology website. https://soap.org/SOAP-Enhanced-Recovery-After-Cesarean-Consensus-Statement.pdf. Accessed Aug 25, 2020.
  2. Nelson G, Bakkum-Gamez Z, Kalogera E, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS®) Society recommendations—2019 update. Int J Gynecol Cancer. 2019;29(4):651-668.
  3. Modesitt SC, Sarosiek BM, Trowbridge ER, et al. Enhanced recovery implementation in major gynecologic surgeries: effect of care standardization. Obstet Gynecol. 2016;128(3):457-466.
  4. Chapman JS, Roddy E, Ueda S, Brooks R, Chen LL, Chen LM. Enhanced recovery pathways for improving outcomes after minimally invasive gynecologic oncology surgery. Obstet Gynecol. 2016;128(1):138-144.
  5. Hedderson M, Lee D, Hunt E, et al. Enhanced recovery after surgery to change process measures and reduce opioid use after cesarean delivery: a quality improvement initiative. Obstet Gynecol. 2019;134(3):511-519.
  6. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. ACOG Committee Opinion No. 750: Perioperative pathways: enhanced recovery after surgery. Obstet Gynecol. 2018;132(3):e120-e130.
  7. Lefkowits C, Duska L. Opioid use in gynecologic oncology; balancing efficacy, accessibility and safety: an SGO clinical practice statement. Gynecol Oncol. 2017;144(2):232-234.

Indication

EXPAREL® (bupivacaine liposome injectable suspension) is indicated for single-dose infiltration in patients aged 6 years and older to produce postsurgical local analgesia and in adults as an interscalene brachial plexus nerve block to produce postsurgical regional analgesia. Safety and efficacy have not been established in other nerve blocks.

Important Safety Information

  • EXPAREL is contraindicated in obstetrical paracervical block anesthesia.
  • Adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via infiltration were nausea, constipation, and vomiting; adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via interscalene brachial plexus nerve block were nausea, pyrexia, and constipation.
  • Adverse reactions with an incidence greater than or equal to 10% following EXPAREL administration via infiltration in pediatric patients six to less than 17 years of age were nausea, vomiting, constipation, hypotension, anemia, muscle twitching, vision blurred, pruritis, and tachycardia.
  • If EXPAREL and other non-bupivacaine local anesthetics, including lidocaine, are administered at the same site, there may be an immediate release of bupivacaine from EXPAREL. Therefore, EXPAREL may be administered to the same site 20 minutes after injecting lidocaine.
  • EXPAREL is not recommended to be used in the following patient populations: patients <6 years old for infiltration, patients younger than 18 years old for interscalene brachial plexus nerve block, and/or pregnant patients.
  • Because amide-type local anesthetics, such as bupivacaine, are metabolized by the liver, EXPAREL should be used cautiously in patients with hepatic disease.

Warnings and Precautions Specific to EXPAREL

  • Avoid additional use of local anesthetics within 96 hours following administration of EXPAREL.
  • EXPAREL is not recommended for the following types or routes of administration: epidural, intrathecal, regional nerve blocks other than interscalene brachial plexus nerve block, or intravascular or intra-articular use.
  • The potential sensory and/or motor loss with EXPAREL is temporary and varies in degree and duration depending on the site of injection and dosage administered and may last for up to 5 days, as seen in clinical trials.

Warnings and Precautions for Bupivacaine-Containing Products

  • Central Nervous System (CNS) Reactions: There have been reports of adverse neurologic reactions with the use of local anesthetics. These include persistent anesthesia and paresthesia. CNS reactions are characterized by excitation and/or depression.
  • Cardiovascular System Reactions: Toxic blood concentrations depress cardiac conductivity and excitability, which may lead to dysrhythmias, sometimes leading to death.
  • Allergic Reactions: Allergic-type reactions (eg, anaphylaxis and angioedema) are rare and may occur as a result of hypersensitivity to the local anesthetic or to other formulation ingredients.
  • Chondrolysis: There have been reports of chondrolysis (mostly in the shoulder joint) following intra-articular infusion of local anesthetics, which is an unapproved use.
  • Methemoglobinemia: Cases of methemoglobinemia have been reported with local anesthetic use.

Please refer to full Prescribing Information.

See More

EXPAREL® (bupivacaine liposome injectable suspension) is indicated for single-dose infiltration in patients aged 6 years and older to produce postsurgical local analgesia and in adults as an interscalene brachial plexus nerve block to produce postsurgical regional analgesia. Safety and efficacy have not been established in other nerve blocks.

Important Safety Information